Infectious Diseases II
iii.
CAUTI: In patients with indwelling urethral, indwelling subrapubic, or intermittent
catheterization, CAUTI is defined by the presence of symptoms or signs compatible with
a UTI with no other identified source of infection, together with 103 CFU/mL or more of 1
bacterial species in a single catheter urine specimen or in a midstream-voided urine specimen
from a patient whose urethral, suprapubic, or condom catheter has been removed within the
previous 48 hours. Lower colony counts are more likely to represent significant bacteriuria in a
symptomatic person than in an asymptomatic person.
Up to 80% of UTIs are caused by urinary catheterization.
More than 5% of postoperative patients will experience a UTI.
CAUTIs account for $300β$400 million in additional health care costs per year.
| d. | CAUTI is considered a preventable complication. CMS no longer provides reimbursement to |
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providers for the treatment of CAUTIs.
Etiology
Most pathogens causing CAUTIs are acquired from the external environment, including the urethra,
the catheter collection system, and local skin flora. Most short-term CAUTIs are monomicrobial.
Longer duration of an indwelling catheter is associated with the formation of biofilms within the
catheter and related system, which can promote polymicrobial infections.
E coli is the most prevalent pathogen causing CAUTIs; however, E coli accounts for only about
one-third of CAUTIs. Additional bacterial pathogens include other enteric gram-negative bacilli
(e.g., Klebsiella spp; Proteus spp; Enterobacter spp); nonβlactose-fermenting, gram-negative bacilli
(e.g., P aeruginosa); and gram-positive cocci (e.g., Enterococcus spp; methicillin-susceptible
S aureus [MSSA]; MRSA; methicillin-resistant Staphylococcus epidermidis [MRSE]). Candida
spp may be involved in up to one-third of CAUTIs.
Similar to other health careβassociated infections, causative pathogens are associated with local
pathogen patterns, pathogen-specific risk factors, and patient severity of illness.
Risk factors: Not maintaining a closed drainage system, female sex, increased duration of catheterization,
and older age
Prevention strategies
The most effective way to reduce the incidence of catheter-associated bacteriuria and CAUTI is to
minimize the use of urinary catheters by restricting their use to patients who have a clear indication
and by removing the catheter as soon as it is no longer needed. In addition, urinary catheters should
be removed within 24 hours postoperatively, if possible.
The foundation for preventing CAUTIs includes training and education, proper aseptic insertion
techniques, and active surveillance and performance improvement systems.
Pharmacists may provide reminders as part of a multidisciplinary effort to minimize the
placement and duration of urinary catheters.
Recommended best practices for preventing CAUTIs have been proposed and endorsed by IDSA,
SHEA, CDC, and TJC. These evidence-based recommendations are categorized as essential
practices for all acute care hospitals. The entire document is available at Infect Control Hosp
Epidemiol. 2023;44(8):1209-1231. Major recommendations include:
Essential practices
| (a) | Insert urinary catheters only when necessary for patient care, and leave in place only as |
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long as indications remain.
| (b) | Provide comprehensive education to and ensure competency for all involved with insertion, |
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care, and maintenance of urinary catheters.
| (c) | Use a systematic process or checklist at the time of insertion to ensure adherence to proper |
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insertion technique.